The epidemic of drug overdoses, often perceived as a largely white rural problem, made striking inroads among black Americans last year — particularly in urban counties where fentanyl has become widespread.Although the steep rise in 2016 drug deaths has been noted previously, these are the first numbers from the Centers for Disease Control and Prevention to break down 2016 mortality along geographic and racial lines. They reveal that the drug death rate is rising most steeply among blacks, with those between the ages of 45 and 64 among the hardest hit.

Drug deaths among blacks in urban counties rose by 41 percent in 2016, far outpacing any other racial or ethnic group. In those same counties, the drug death rate among whites rose by 19 percent. The data, released on Thursday, suggests that the common perception of the epidemic as an almost entirely white problem rooted in overprescription of painkillers is no longer accurate, as fentanyl, often stealthily, invades broader swaths of the country and its population.

Driven by the continued surge in drug deaths, life expectancy in the United States dropped for the second year in a row last year. It’s the first consecutive decline in national life expectancy since 1963. Drug overdoses have now surpassed heart disease as the leading cause of death for Americans under the age of 55.In Washington, D.C., the emergence of fentanyls caused the rate of drug deaths to double in a single year. The rate of drug deaths there is now on par with those in Ohio and New Hampshire. It’s an unsurprising consequence of an epidemic that is both widespread and extremely localized. If fentanyls enter the drug supply in one area, deaths can accumulate rapidly. Drug deaths are also up sharply in cities like St. Louis, Baltimore, Philadelphia and Jacksonville, Fla.Dr. Andrew Kolodny, the co-director of opioid policy research at Brandeis University’s Heller School for Social Policy and Management, said it appeared that many of the African-Americans who died were older men who had become addicted to heroin during a previous epidemic in the 1970s. “Despite beating the odds for the past 40 to 50 years,” he said, “they’re dying because the heroin supply has never been so dangerous — increasingly it’s got fentanyl in it or it’s just fentanyl sold as heroin.”

Fentanyl-laced cocaine, too, may be playing a role. A studypublished this month in the journal Annals of Internal Medicine found that cocaine-related overdose deaths were nearly as common among black men between 2012 and 2015 as deaths due to prescription opioids in white men over the same period. Cocaine-related deaths were slightly more common in black women during that period than deaths due to heroin among white women, according to the study. But it also found that the largest recent increases in overdose deaths among blacks were attributed to heroin. One of the researchers, David Thomas of the National Institute on Drug Abuse, said he did not know whether some of the cocaine-attributed deaths in the study involved fentanyl, although he had heard anecdotally of such mixing.The study, by researchers at the National Cancer Institute and the National Institute on Drug Abuse, also found that the recent rise in overdose death rates was sharpest among older blacks. The same held true last year in New York City.“What’s really interesting is you’re not seeing younger blacks getting involved in heroin as much,” said Denise Paone, senior director of research and surveillance in the city’s Bureau of Alcohol and Drug Use Prevention.Across the board, though, fentanyl has caused a huge spike in overdose deaths in New York in just the last year. Fentanyl played a role in about 16 percent of overdose deaths in 2015 and 44 percent in 2016, Dr. Paone said, compared with 3 percent in prior years. A growing number of the deaths involve cocaine cut with fentanyl, she added — which is probably particularly deadly for someone who has not used opioids before.In Ohio, which had the nation’s second-highest overdose rate last year, the medical examiner in Cuyahoga County told a United States Senate subcommittee in May that a fast-rising rate of fentanyl-related deaths among blacks was probably a result of drug dealers mixing fentanyl with cocaine. In Cuyahoga County (the home of Cleveland), fentanyl contributed to the deaths of five African-Americans in 2014, 25 in 2015 and 58 in 2016. But both opioids and cocaine still kill far more whites than blacks there.TO CONTINUE READING AND SEE MAP AND CHARTS:​ https://www.nytimes.com/interactive/2017/12/22/upshot/opioid-deaths-are-spreading-rapidly-into-black-america.html?emc=edit_th_20171222&nl=todaysheadlines&nlid=35747334

Over the last few years, I have watched with a blend of amazement and grave concern as an odd phenomenon has unfolded against the backdrop of our nation’s opioid crisis: Despite the clear need to battle this ongoing epidemic with all of the tools at our disposal, one evidence-proven option — supervised injection facilities — is being overlooked, and even disparaged.Back in the spring, the Massachusetts Medical Society began advocating for the establishment of a pilot supervised injection facility in the commonwealth of Massachusetts. It was not an easy decision because physicians don’t want to condone, or to be seen as condoning, the use of illicit drugs. Yet after close review and thorough debate, it was clear that the data supported their use.A supervised injection facility is a safe, clean space where individuals can inject drugs they already possess under the supervision of trained medical staff. The facilities also offer sterile injection equipment. The advantage is that medical expertise is immediately present in case an emergency occurs. At the same time, these on-site clinicians can facilitate pathways to treatment and rehabilitation from the chronic disease of opioid abuse disorder.

Such sites provide an alternative to dangerous injection tactics like syringe sharing, syringe reuse, and improper disposal of soiled injection materials, all of which can lead to infection with HIV and hepatitis C, as well as other painful and hard-to-treat infections that can attack the heart, bones, and other organs.As a physician and president of the Massachusetts Medical Society, I was initially inclined to oppose the concept of supervised injection facilities. How, I thought, could a health care professional, someone grounded in ethics and an oath to “do no harm,” stand by and watch as individuals inject street drugs into their veins?

Yet the opioid crisis and the frightening rate at which it has accelerated doesn’t allow for the outright dismissal of this idea — or any others — that could have prevented even one of the more than 60,000 deaths caused by drug overdoses in the United States last year.As a health care professional, I can’t stand idly by with the knowledge that a better way exists for reaching and caring for those suffering from the disease of addiction. We can’t allow individuals to die cruel deaths alone in alleyways or under the cover of darkness in public parks.

The concept of supervised injection facilities fits well with the overarching and proven public health philosophy of harm reduction: meeting patients where they are in their disease to eliminate existing barriers to rehabilitation.

You’ve likely heard of hepatitis C, a disease intravenous drug users have contracted from using needles unsafely. But hepatitis is much more complex. As local and national headlines focus on the opioid crisis and the deaths related to the epidemic, there is an overlooked and devastating virus spread in correlation with opioid abuse and injection drug users, especially in the Appalachia region.Hepatitis C is a virus transmitted via the blood of the infected individual. According to the Centers for Disease Control and Prevention, hepatitis C is most commonly transmitted by injection drug use.Many of the new cases of hepatitis C in Appalachia are individuals younger than 30 years who report intravenous drug use and opioid dependency. Initiatives to reduce transmission of the virus, such as required screenings, need to be a priority for Tennessee.

Hepatitis C is often called a “silent killer.” There are very few symptoms associated with the virus until long-term complications emerge such as liver cancer or cirrhosis.Persons infected with the virus, unaware of their status, unknowingly transmit the virus. According to the Tennessee Department of Health, more than 100,000 individuals may be living with the virus in Tennessee.Acute cases of hepatitis C doubled from 2011 to 2015 in Tennessee based on statistics from the Centers for Disease Control and Prevention. Healthcare costs for individuals diagnosed with the virus are rising and will continue to rise as more individuals are infected with the virus.

According to the American Association for the Study of Liver Diseases, the cost of hepatitis C in American in 2015 increased to $21 billion.

The American epidemic of opioid abuse is finally getting the attention it warrants. While policy solutions continue to be inadequate, the decision by President Trump to declare a national opioid emergency has helped to increase discussion about the problem and how the country can solve it. But the conversation also needs to address a dangerous – and largely ignored – interconnected public health crisis wreaking havoc among young Americans.

​The problem is that more Americans than ever are injecting opioids and inadvertently infecting themselves with hepatitis C. Shared needles mean shared blood-borne infections – and that’s how the opioid crisis has created a new generation of hepatitis C patients. The number of reported hepatitis C infections nearly tripled from 2010 to 2015, with the virus is spreading at an unprecedented rate among young people under 30 – who are now, for the first time, the most at-risk population for contracting and transmitting hepatitis C.In the United States, an estimated 3.5 million people, and likely more, are currently living with hepatitis C. The virus kills nearly 20,000 Americans each year – more than HIV and all other infectious diseases combined.

​Hepatitis C attacks the liver, causing cirrhosis — or scarring of the liver — and leads to severe liver damage, liver cancer and liver failure. The virus is the leading cause of liver cancer — the fastest-growing cause of cancer mortality in the U.S., which kills twice as many Americans now than it did in the 1980s. Driven by young people who inject drugs, new cases of liver disease have nearly tripled nationwide in just a few years.

​Fortunately, we now have an unprecedented chance to eliminate the virus. More and more treatments are available that provide cure rates of over 95 percent, without the debilitating side-effects of older and far less effective hepatitis C therapies. These newer treatments, known as direct-acting antivirals, eliminate the hepatitis C virus from the body, stopping the virus’ attack on the liver and preventing the patient from infecting others.While some of these treatments made national headlines for their initial $1,000-a-pill sticker prices, that time has passed. Due to increased competition as new treatment options have entered the market over the last three years, the cost of a cure has dropped dramatically. The price will decrease even further as additional alternative cures are approved.For too many Americans, however, barriers to getting cured remain. While access has increased significantly for the more than 216 million Americans with private insurance and the 53 million who have Medicare, state Medicaid programs are a different story. The more than 70 million low-income Americans covered by Medicaid, including low-income adults, children, pregnant women, seniors, and people with disabilities, continue to face severely limited access to cures for hepatitis C.

“The findings really underscore how dangerous AA is,” Steven Rozen, senior author of the study and a professor from Duke-NUS Medical School in Singapore, told NBC News. “And now we have a smoking gun with respect to liver cancers.”Scientists also looked at data on mutations from 1,400 liver cancers from across the world and found that 47 percent of those from China and 29 percent of those from Southeast Asia showed evidence of exposure to AA. Lower percentages were found in Korea (13 percent), Japan (2.7 percent), North America (4.8 percent), and Europe (1.7 percent).AA is found in aristolochia and asarum plants, which are used in traditional medicine for a variety of purposes, including weight loss and slimming.The chemical was banned in Europe in 2001 and in Singapore since 2004; China restricts the use of some plants containing AA; and in the United States, the sale of herbs with the compounds is unregulated as long as they are labeled accurately and contain no health benefit claims, study authors wrote.In Taiwan, some herbs containing the chemicals were banned in 2003, but the law excluded a group of plants containing the compounds, Rozen said, adding that the prohibited plants were still being widely prescribed the year after the ban. Researchers wrote that they detected no significant difference in the prevalence of AA in liver cancer patients before and after the ban.A reason for this could be that plants containing the compound are still widely available online, Rozen said.“In some cases, regulations could probably be improved,” he added.

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